Germinoma pathophysiology: Difference between revisions

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Revision as of 16:34, 10 February 2016

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Pathophysiology

Gross pathology

On gross examination, the external surface is smooth and bosselated (knobby), and the interior is soft, fleshy and either cream-coloured, gray, pink or tan.

Microscopic pathology

Microscopic examination typically reveals uniform cells that resemble primordial germ cells. Typically, the stroma contains lymphocytes and about 20% of patients have sarcoid-like granulomas. The tumor is uniform in appearance, consisting of large, round cells with vesicular nuclei and clear or finely granular cytoplasm that is eosinophilic. Pure germinomas are composed of large polygonal undifferentiated cells with abundant cytoplasm arranged in nests separated by bands of connective tissue. The histologic appearance of Nongerminomatous germ cell tumors (NGGCTs) varies depending upon the specific cell types present.

Pathogenesis

Central nervous cell germ cell tumors (GCTs) are believed to arise from nests of embryonic cells arrested during their migration in fetal development in the midline structures. As a result, CNS GCTs are found in midline sites, especially in the suprasellar and pineal gland regions.

References

Template:WikiDoc Sources

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 ==Overview==
-The term ''germinoma'' most often has referred to a [[tumor]] in the [[brain tumor|brain]] that has a [[histology]] identical to two other tumors: [[#Ovary_.28dysgerminoma.29|dysgerminoma]] in the [[ovarian cancer|ovary]] and [[seminoma]] in the [[testicular cancer|testis]].<ref>{{cite web |url=http://www.med-ed.virginia.edu/courses/path/gyn/ovary3.cfm |title=Pathology |accessdate=2007-11-03 |format= |work=}}</ref> Increasingly, the term refers to any tumor with this histology, regardless of where it occurs in the body.
-[[MeSH]] defines germinoma as "a [[malignant]] [[neoplasm]] of the [[germ cell|germinal]] [[tissue]] of the [[gonad]]s; [[mediastinum]]; or [[pineal]] region"<ref>{{MeshName|Germinoma}}</ref> and within its scope includes both dysgerminoma and seminoma. Collectively, these are the '''seminomatous''' or '''germinomatous''' tumors.
 ==Pathophysiology==
 ===Gross pathology===
-On gross examination, the external surface is smooth and bosselated (knobby), and the interior is soft, fleshy and either cream-coloured, gray, pink or tan. Microscopic examination typically reveals uniform cells that resemble primordial germ cells. Typically, the [[stroma]] contains [[lymphocyte]]s and about 20% of patients have sarcoid-like [[granuloma]]s.
+On gross examination, the external surface is smooth and bosselated (knobby), and the interior is soft, fleshy and either cream-coloured, gray, pink or tan.
-====Ovary (dysgerminoma)====
-Dysgerminoma is the most common type of [[malignant]] [[germ cell]] [[ovarian cancer]]. Dysgerminoma usually occurs in [[adolescence]] and early adult life; about 5% occur in pre-pubertal children. Dysgerminoma is extremely rare after age 50. Dysgerminoma occurs in both ovaries in 10% of patients and, in a further 10%, there is microscopic tumor in the other ovary.
-Abnormal [[gonad]]s (due to [[gonadal dysgenesis]] and [[androgen insensitivity syndrome]]) have a high risk of developing a dysgerminoma. Most dysgerminomas are associated with elevated serum [[lactic dehydrogenase]] (LDH), which is sometimes used as a [[tumor marker]].
-[[Metastases]] are most often present in the [[lymph node]]s.
-====Intracranial germinoma====
-Intracranial germinoma occurs in 0.7 per million children.<ref>{{cite journal |author=Keene D, Johnston D, Strother D, ''et al'' |title=Epidemiological survey of central nervous system germ cell tumors in Canadian children |journal=J. Neurooncol. |volume=82 |issue=3 |pages=289–95 |year=2007 |pmid=17120159 |doi=10.1007/s11060-006-9282-2}}</ref> As with other [[germ cell tumor]]s (GCTs) occurring outside the [[gonad]]s, the most common location of intracranial germinoma is on or near the midline, often in the [[pineal]] or [[suprasellar]] areas; in 5-10% of patients with germinoma in either area, the tumor is in both areas. Like other (GCTs), germinomas can occur in other areas of the brain. Within the [[brain]], this tumor is most common in the [[hypothalamic]] or [[epiphysial]] regions. In the [[thalamus]] and [[basal ganglia]], germinoma is the most common GCT.
 ===Microscopic pathology===
-The tumor is uniform in appearance, consisting of large, round [[cell (biology)|cells]] with vesicular [[Cell nucleus|nuclei]] and clear or finely granular [[cytoplasm]] that is [[eosinophilic]].
+Microscopic examination typically reveals uniform cells that resemble primordial germ cells. Typically, the [[stroma]] contains [[lymphocyte]]s and about 20% of patients have sarcoid-like [[granuloma]]s. The tumor is uniform in appearance, consisting of large, round cells with vesicular nuclei and clear or finely granular cytoplasm that is eosinophilic. Pure germinomas are composed of large polygonal undifferentiated cells with abundant cytoplasm arranged in nests separated by bands of connective tissue. The histologic appearance of Nongerminomatous germ cell tumors (NGGCTs) varies depending upon the specific cell types present.
+===Pathogenesis===
+Central nervous cell germ cell tumors (GCTs) are believed to arise from nests of embryonic cells arrested during their migration in fetal development in the midline structures. As a result, CNS GCTs are found in midline sites, especially in the suprasellar and pineal gland regions.
 ==References==
 {{reflist|2}}